Composite Spasticity Index (CSI)
Original Editor - Arnold Fredrick D'Souza
Top Contributors - Arnold Fredrick D'Souza, Chloe Waller, Lucinda hampton and Kim Jackson
Objective[edit | edit source]
The Composite Spasticity Index (CSI) is used for the quantification of spasticity in hemiparetic limbs.[1]
Intended Population[edit | edit source]
It is intended for use in patients with stroke[1], spinal cord injury and cerebral palsy[2].
Method of Use[edit | edit source]
The CSI has three components:
- Tendon jerk
- Resistance to passive flexion
- Clonus
Tendon jerk[edit | edit source]
The biceps, triceps, patellar, or Achilles tendon can be tested. Ensure sufficient force is used while tapping the tendon so as to elicit a 'maximal' reflex jerk and compare the result with the unaffected limb.[1]
| 0 | No response |
| 1 | Normal response |
| 2 | Mildly hyperactive response |
| 3 | Moderately hyperactive response |
| 4 | Maximally hyperactive response |
Resistance to passive stretch[edit | edit source]
The resistance felt during this test allows the examiner to evaluate the hyperactivity of the tonic stretch reflex. The stretch must be performed at moderate speed (>100 degrees per second).[1]
Note the presence of contractures and/or a clasp-knife response before examination[2].
| 0 | No resistance (hypotonic) |
| 2 | Normal resistance |
| 4 | Mildly increased resistance |
| 6 | Moderately increased resistance |
| 8 | Maximally increased resistance |
This item is doubly weighted due to its close relation to hypertonus.
Clonus[edit | edit source]
On rapid flexion of the wrist or ankle, the examiner notes the number of beats of clonus (if present).[1]
| 1 | Clonus not elicited |
| 2 | 1-3 beats of clonus elicited |
| 3 | 3-10 beats of clonus elicited |
| 4 | Sustained clonus |
Interpretation[edit | edit source]
The composite score (sum of scores from each component) is used to ascertain the severity of spasticity.[1]
| 0-9 | Mild |
| 10-12 | Moderate |
| 13-16 | Severe |
Evidence[edit | edit source]
Reliability[edit | edit source]
The CSI has excellent test-retest reliability (r = 0.87)[3].
Validity[edit | edit source]
The CSI is valid for the examination of spasticity in elbow flexors.[4]
Responsiveness[edit | edit source]
The responsiveness of the CSI has not been studied.
Links[edit | edit source]
A copy of the outcome measure can be found here.
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Calota A, Levin MF. Tonic stretch reflex threshold as a measure of spasticity: implications for clinical practice. Top Stroke Rehabil. 2009 May-Jun;16(3):177-88.
- ↑ 2.0 2.1 Stroke Engine. Composite Spasticity Index. Available from: https://strokengine.ca/en/assessments/composite-spasticity-index-csi/#:~:text=Index%20(CSI)%20provides%20a%20clinical,patients%20with%20hemiparesis%20following%20stroke (Accessed 21/08/2022)
- ↑ Levin MF, Hui-Chan CW. Conventional and acupuncture-like transcutaneous electrical nerve stimulation excite similar afferent fibers. Arch Phys Med Rehabil. 1993 Jan;74(1):54-60.
- ↑ Levin MF, Feldman AG. The role of stretch reflex threshold regulation in normal and impaired motor control. Brain Res. 1994 Sep 19;657(1-2):23-30.
